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SEND – SEND - Endocrinology and Diabetes (Specialty Certificate Examination)

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Showing 1–3 of 10 questions

Question 1

A 43-year-old man presented with a 2-year history of tiredness and reduced libido. He had not been found to have diabetes mellitus.

On examination, his body mass index was 22.4 kg/m2 (18–25), he was poorly virilised and had 10 mL testes.

Investigations:

serum cortisol (09.00 h) 220 nmol/L (200–700)

serum testosterone 4 nmol/L (9.0–35.0)

plasma follicle-stimulating hormone 1.2 U/L (1.0–7.0)

plasma luteinising hormone 1.2 U/L (1.0–10.0)

serum prolactin 150 mU/L (<360)

serum thyroid-stimulating hormone 1.2 mU/L (0.4–5.0)

serum free T4 8.2 pmol/L (10.0–22.0)

serum insulin-like growth factor 1 7.8 nmol/L (5.6–23.3)

MR scan of pituitary empty sella; no mass lesion

An insulin tolerance test was advised to assess both cortisol and growth hormone reserve.

What is the most appropriate dose of insulin (in units/kg body weight) to administer?

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  • ○

    0.01
  • ○

    0.05
  • ○

    0.1
  • ○

    0.5
  • ○

    1.0
Question 2

A 17-year-old boy with type 1 diabetes mellitus was admitted with diabetic ketoacidosis precipitated by a recent viral illness.

Investigations on admission:

random plasma glucose 15.0 mmol/L

arterial blood gases, breathing air:

pH 7.07 (7.35–7.45)

H+ 85 nmol/L (35–45)

Investigations after initial treatment with fluids, insulin and potassium 7 h after admission:

random plasma glucose 4.0 mmol/L

serum bicarbonate 10 mmol/L (20–28)

At this stage, he was being given infusions of insulin (1 U/h) and glucose 5% (100 mL/h).

What is the most appropriate next step in management?

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  • ○

    continue current regimen
  • ○

    continue current regimen but encourage oral carbohydrate intake
  • ○

    continue insulin infusion and change glucose to a higher concentration
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    give intravenous sodium bicarbonate
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    stop insulin infusion if glucose falls any further, then repeat plasma glucose in 15 min
Question 3

A 28-year-old man was seen in the lipid clinic following a referral from the general surgical team. He had had two episodes of acute pancreatitis over the preceding 6 months, which settled spontaneously. He had a past medical history of HIV disease and was taking highly active antiretroviral (HAART) therapy. He drank 12 units of alcohol per week.

On examination, he had no stigmata of hyperlipidaemia.

Investigations:

fasting plasma glucose 6.2 mmol/L (3.0–6.0)

haemoglobin A1c 44 mmol/mol (20–42)

serum cholesterol 7.5 mmol/L (<5.2)

fasting serum triglycerides 23.70 mmol/L (0.45–1.69)

serum thyroid-stimulating hormone 0.7 mU/L (0.4–5.0)

serum free T4 14.3 pmol/L (10.0–22.0)

What class of antiretroviral drug is the most likely cause of his metabolic disturbance?

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  • ○

    entry inhibitors (e.g. enfuvirtide)
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    integrase inhibitors (e.g. raltegravir)
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    non-nucleoside reverse transcriptase inhibitors (e.g. nevirapine)
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    nucleoside reverse transcriptase inhibitors (e.g. zidovudine)
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    protease inhibitors (e.g. ritonavir)